Provider Demographics
NPI:1962405621
Name:SAMSON, STEPHEN A (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:SAMSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8740 N KENDALL DR
Mailing Address - Street 2:STE 111
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2209
Mailing Address - Country:US
Mailing Address - Phone:305-595-1548
Mailing Address - Fax:305-595-5269
Practice Address - Street 1:8740 N KENDALL DR
Practice Address - Street 2:STE 111
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2209
Practice Address - Country:US
Practice Address - Phone:305-595-1548
Practice Address - Fax:305-595-5269
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 4160122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist